Published: 14/04/2005, Volume II5, No. 5951 Page 28 29 30 31

The mooted closure of health services can turn the mildest citizen into a raging bull, someone who is prepared to fight for a cause for years on end. Emma Forrest meets three bands of campaigners to find out what motivates them in their sometimes bitter wars with the NHS

You are an NHS manager. You have been given a career-shaping project - the chance to help redesign local services. Then you hear that local residents are not happy with your plans and an action group has formed to stop them. Over the next four pages HSJ meets people who have devoted themselves to campaigning for a part of the health service that means a lot to them.

Dacorum Hospital Action Group

It is unlikely there is an NHS manager in west Hertfordshire who does not know the name Zena Bullmore. Ms Bullmore, 84, chairs the Dacorum Hospital Action Group and is something of a local heroine. She has been campaigning to keep services open at Hemel Hempstead Hospital for nearly 30 years.

I arrange to talk to her at a meeting of Hertfordshire council's joint health scrutiny and overview committee. She is a tiny, neatly dressed lady with a panic button round her neck and a walking stick. On a chilly March day she looks as though she should be at home keeping warm, not spending four hours in a council chamber.

Her appearance is her secret weapon. She looks like a little old lady, so managers think she is harmless and probably a bit dotty. But then she starts quoting average waits and budget constraints. As Ms Bullmore gives evidence on the proposed moving of Hemel Hempstead Hospital's children's ward to Watford General Hospital, her frustration at the treatment of local services becomes clear. The meeting does not go her way - the motion to refer the changes to the health secretary loses by 10 votes to three - but her energy seems undimmed. In fact, she is philosophical: 'We got one more vote than last time.' Ms Bullmore manages to attend all the group's meetings and other events like the scrutiny committee because Hemel Hempstead patient forum chair Edie Glatter gives her a lift everywhere. 'We have been friends for umpteen years. Her mother lives in Australia, so I am a sort of mother to her, ' says Ms Bullmore, 'though I expect we both seem like old ladies to you'.

A former teacher, Ms Bullmore moved to Hemel Hempstead when she married in 1948. Before that she was a councillor on Westminster council in London, but has steered clear of community health council or patient forum membership since becoming involved in campaigning. 'That way, I can stay independent, ' she says.

The campaigning began with the intention of annoying a pompous local official. 'When we started we thought it would just be a case of getting money that had been promised for a new building at the hospital. I was at a meeting about it when the then leader of the council came to speak to us. When I said what was going on was not good enough, he said: 'Well, why do not you do something about it then?' So I said I would.

We hated each other, you see.'

She continues: 'But then we discovered that they were going to close the hospital and what we thought would take a year has taken 29-and-ahalf years so far.' Surprisingly, despite her fierce loyalty to the hospital, until recently Ms Bullmore had not had to use its services since last giving birth 43 years ago. So why the attachment?

'I can't stand the public being treated with contempt, ' she says. 'Anger can be positive. People still talk as if the public are unimportant; they consult and then ignore the results of the consultations and that is something I cannot stand. I have a very strong sense of justice.

'The only excuse for closing a hospital is a reduction in the local population and as there are going to be 79,000 new homes built in Hertfordshire, we should be getting more development at the hospital, not less.' Breaking her hip last year gave her a new insight into what it is like to access health services. 'I am fit for my age but you still have to get over the shock. I get so angry with people who do not know what it is like on the wards. I was in a bay that they called 'the hips'. We all had broken hips, and two of the ladies had Alzheimer's and they were scared. But the nurses were so wonderful with them.' Past highlights of the Dacorum group's campaign include a 33,000-strong petition to keep the hospital open and creating a human chain around the building on Valentine's Day in 2004. The group also forced an Advertising Standards Agency ruling on a strategic health authority consultation, which found it had exaggerated levels of public support for the proposals affecting Hemel Hempstead hospital.

Ms Bullmore met prime minister Tony Blair at a Number 10 reception for 'unsung' community heroes, and was also awarded an MBE for her work for the community in 1986.

Much of the campaign's work involves doing research into any proposed change to the Hemel Hempstead services, such as visiting the children's wards and interviewing staff. At the 20strong committee meetings, work is divvied out.

Ms Bullmore stresses that she is only the chair, one of many people fighting to save the hospital.

She knows she will have to resign her position at some point, but hopes to be involved in the campaign as long as possible. The future of services in the area remains uncertain and she will continue to try to make the authorities listen. 'Their way of dealing with people is to get rid of them, but they can't get rid of me, ' she says.

'I have the gift of the gab, and I am not afraid.' And she is charmingly frank on how she thinks the health authority views her. 'I am a nuisance to them, are not I? We show them up. When I broke my hip the strategic health authority sent me a wonderful basket of flowers - but they were wishing I would die on them. I gave the flowers to the nurses.'

Save Cossham Hospital Action Group Victory!

The group of pensioners fighting to save Cossham Hospital in the Kingswood area of Bristol has won. Proposals to close the hospital and move its services to primary care facilities - leaving the building free to be sold for conversion by developers - were part of the Bristol health services plan. The action group had already secured an extension to consultation on the plans after local residents, mobilised by the group, complained their opinion had not been sufficiently canvassed and that the plans were being considered separately to the rest of the plan.

Meeting the group - before the decision to keep open the hospital - is not easy. Founder Dolores Powell is initially suspicious. She suspects I may be working for the NHS. I am barred from sitting in on its committee meeting, held, ironically, in the hospital boardroom.

Having two hours to kill gives me a chance to walk around the hospital. It feels like stepping into the pages of NHS history. The atmosphere is far from the brand-conscious air of the average modern hospital.

It is clear the building has seen better days - though it is in no worse shape than many a Victorian hospital - but the personal touch is everywhere. The cleaners have all worked at Cossham for at least 20 years and the security guard lives across the road. He tells me that vandalism has fallen off since he started the night shift. He knows all the local kids.

Though a notice in the reception announces that because of the uncertain future of the hospital active fundraising by the Cossham League of Friends has stalled, there are reminders of past activities: one notice says that for a donation the hospital's flag can be raised in someone's honour for a day and their name displayed on a plaque in reception. Tables in upstairs corridors are topped with petitions against the closure.

When I join them later, the group tells me about a long list of equipment the League of Friends has raised funds for, including a scanner, which was donated only a year ago.

Chair Graham Kennedy, who is friendly but guarded, introduces me to the dozen or so committee members. Ms Powell, a small, smart woman, is friendlier than her initial reserve suggests, though her broad smile vanishes when she is talking about the downgrading of services at Cossham and the fight to keep it open. She has been campaigning against the closure of different services at the hospital for 40 years, beginning with a march through Kingswood of young mothers when her children were small.

Mr Kennedy and Ms Powell both began their own separate groups protesting against the closure last year. Mr Kennedy had previously campaigned against the closure of a railway branch line in Portishead.

When Mr Kennedy heard Ms Powell talking about the Cossham closure on local radio, he got in touch so they could join forces. 'Before we had our first meeting I spent 10 days just reading all the documents around this to have some understanding of it, ' he says.

The group is adamant that instead of being progressively downgraded, Cossham Hospital could become a centre of locally based care. Its accident and emergency department closed in the 1980s, it is several years since it housed any inpatient wards and it is now home to a mixed bag of community services.

The group's indignation about the plans are fuelled by the fact that the original hospital building was actually gifted to the community by Handel Cossham, a local businessman. As they see it, the building is not the NHS's to sell. And as South Gloucestershire primary care trust had released details of an extensive upgrade plan in 2002, they are convinced that those plans were changed only when the extent of North Bristol trust's financial problems became clear.

Soon after the campaign began, around 400 people marched through Kingswood to protest against the closure, and an opinion poll was run with the help of the local paper. A long round of parish council, council scrutiny and sub-scrutiny committees, patient and public involvement forums and board meetings followed.

'Between January and April last year the average attendance at their meetings was 25. It was very poorly advertised, ' says Ms Powell. 'After we got the campaign started, between September and December they had 1,600 people attend them, including 310 at our first public meeting.' More events are planned before the consultation closes: demonstrations outside the hospital and Bristol council building. Before that - and on the day after the committee meeting - the group is in action at a public involvement meeting with South Gloucestershire PCT at Cossham Hospital's recreation hall. It is a bitterly cold day and the turnout is dozens rather than hundreds, but those attending do not hesitate to put their views across to senior members of the PCT and North Bristol trust board.

'This could be one of the best hospitals in Bristol again. We do not want its guts torn out and replaced with flats for wealthy people, ' says Ms Powell, summing up the campaign's position and prompting a round of applause. 'The most valuable lesson you can learn from this is to put local people who know the area at the top of decision-making.' She gets several more rounds of applause before the meeting is over. Afterwards, she says she believes public unrest could be possible if the hospital closes - 'We have had riots here in the past' - but Mr Kennedy says he will not even contemplate the possibility of closure. 'Not at the moment. I am retired now but this is a full-time job. I was going to start properly on our allotment this year but I have not even had the chance to finish digging it yet, ' he says. 'If I had known this would take up so much time I might not have started, but so many people have told me I have to carry on and you can't let people down. I do it because It is an injustice.' A few weeks later, despite the proposal being withdrawn, Mr Kennedy is ready to go on fighting. 'We have won the first battle, ' he says.

But the war to secure the hospital's long-term future is not yet over.

Babies First

There are few more emotive subjects than the care of premature or very young babies. The potential closure of the paediatric and maternity services at Pennine Acute Hospitals trust's Fairfield General Hospital in Bury, Lancashire, has touched a nerve.

More than 4,000 people marched through the town last October to protest against the move, which would see facilities replaced by a midwifeled unit and babies in need of specialist care transferred to proposed facilities in Manchester.

The march was organised by Babies First, an action group born from Fairfield Baby Lifeline, a charity which raises money for the Fairfield special care baby unit. Shortly afterwards, and maybe because of the campaign, Greater Manchester strategic health authority said it needed more time to work on the proposals.

Nothing more is expected until June at the earliest.

Babies First's concern now is to make sure that people know the proposals have not gone away.

Its committee meetings are held in a room at the back of Fairfield's canteen. When HSJ meets them one wet evening, former Bury community health council secretary Paul Reynolds and local councillor Pam Walker are by far the most vocal committee members. Many of the other members are trustees of Baby Lifeline, young women whose children spent weeks on the unit after being born early.

There is an animated discussion on whether to invite local MPs and parliamentary candidates to the group's next public meeting. There is a sense of urgency about what work needs to be done.

They discuss how to get enough addresses to get a good quota of returns for a questionnaire, a fundraising dinner and auction (with Olympic medallist Amir Khan's boxing gloves and Manchester United footballer Phil Neville's shirt as prizes) and who can go along to a PCT meeting.

The group received a leaked copy of the last set of proposals and are hoping that the same thing will happen again. But it suspects that when the new proposals emerge little will have changed.

There is also strong concern that Fairfield is going to become an elective hospital, with no emergency services. If children's services can be allowed to leave, they ask, what next? There is a strong sense that time is short, and the fear that babies and young children will have to travel a further eight miles south for treatment is palpable. 'The public think we have won, ' says committee member Jo James. 'We need to make them realise that it is not over and in the summer we might well go back to square one.' The group, and Fairfield Baby Lifeline, is chaired by Dr Said Hany. Energetic and amiable, he is also an associate specialist in paediatrics at the hospital, based at its special care baby unit.

He has worked there since 1988.

'We all felt something had to be done about the proposal and we started the campaign within a week of it being announced last July, ' he says. 'I studied the proposal every night for a week and it did not have a leg to stand on. The charity was never political but we felt so strongly about the unit being dismantled.' Much to his disappointment, Dr Hany couldn't take part in the campaign's most high-profile event to date - the march through Bury - because he was unwell. 'But they took me to the platform at the end of it so I could make a speech. The night before, I was so worried that no one would turn up, but when I remember it now I get goose pimples, ' he says.

'Bury is not a political place and it was the biggest event of its kind ever seen in the town.

When the SHA realised 4,000 people had marched through the town about this, they hit the roof. They did not realise people felt so strongly.' By the time we finish talking it is after 9pm and Dr Hany is going to check on a patient on the children's ward before thinking of heading home.

Ploughing through the paperwork around the Fairfield proposal has also largely fallen to him.

'This is folder number four, ' he says, gesturing to a thick ring-bound folder of documents. 'I work on this every day.' Dr Hany will not comment on the trust's view of his involvement in the campaign, though it is difficult to see it being favourable. 'Sometimes I feel like I should not have got involved, but now I have an obligation, ' he says. 'We have to stand up against this proposal to support the people of Bury. I hate all the politics and back-stabbing, but the people of Bury come first. This is not modernisation; It is victimisation of Bury. The people of this town have been betrayed.' .